Oral Nitrate Administration Ameliorates Cardiogenic Shock due to Eclipsed Mitral Regurgitation

Mai Kimura, Takashi Kohno, Mitsushige Murata, Tadaki Nakahara, Kai Sugihara, Takahiko Nishiyama, Hikaru Tsuruta, Toru Egashira, Yuichiro Maekawa, Mikihiko Kudo, Motoaki Sano, Hideyuki Shimizu, Keiichi Fukuda

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2 Citations (Scopus)

Abstract

Eclipsed mitral regurgitation (MR) has been reported as transient massive functional MR caused by a sudden coaptation defect in the absence of left ventricular remodeling or epicardial coronary artery stenosis. Coronary spasm or microvascular dysfunction has been suggested to be associated with the pathogenesis. Here, we present a 68-year-old woman with eclipsed MR with cardiogenic shock ameliorated by nitrate. She was admitted for transient shock with massive functional MR. Transient MR was associated with a complete absence of mitral leaflet coaptation owing to tethering of the lateral posterior mitral leaflet. The leaflet tethering was triggered by transient myocardial ischemia around the anterolateral papillary muscle, which could have been caused by coronary spasm and/or microvascular dysfunction. During admission, she experienced similar repeated episodes, which were ameliorated by oral nitrate administration. This is the first described case of eclipsed MR with shock ameliorated by nitrate. Although eclipsed MR, a cause of life-threatening shock, is uncommon, we need to keep in mind that nitrate administration could be a treatment option even in patients with cardiogenic shock.

Original languageEnglish
Pages (from-to)327-330
Number of pages4
JournalCardiology (Switzerland)
DOIs
Publication statusAccepted/In press - 2016 Mar 17

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Keywords

  • Cardiogenic shock
  • Mitral regurgitation
  • Nitrate

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Kimura, M., Kohno, T., Murata, M., Nakahara, T., Sugihara, K., Nishiyama, T., Tsuruta, H., Egashira, T., Maekawa, Y., Kudo, M., Sano, M., Shimizu, H., & Fukuda, K. (Accepted/In press). Oral Nitrate Administration Ameliorates Cardiogenic Shock due to Eclipsed Mitral Regurgitation. Cardiology (Switzerland), 327-330. https://doi.org/10.1159/000444182